糖尿病性ケトアシドーシスに合併した急性下腸間膜動脈閉塞症の１手術例

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  • A Case of Acute Inferior Mesenteric Arterial Occlusive Disease with Diabetic Ketoacidosis

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A 71-year-old man undergoing an overnight checkup for pollakiuria and gastromegaly was suspected from labo data to have hyperglycemia, ketonuria (DKA), and metabolic acidosis, and diagnosed with diabetic ketoacidosis. Despite conservative treatment, his gastromegaly gradually worsed, and abdominal CT suggested occlusion of the inferior mesenteric artery (IMA), poor blush of the intestinal wall within the limits of the IMA, and rectal stenosis. Colonoscopy suggested stenosis of the rectum and extensive necrosis at the oral site, yielding a diagnose of extensive colon necrosis caused by inferior mesenteric arterial occlusive disease, necessitating emergency surgery. A necrotic lesion extended from the descending colon to the rectum. We resected the necrotic colon and reconstructed it by end-to-end anastomosis, followed by ileostomy. The postoperative course was uneventful. The cause of disease in this case appeared to be severe hypovolema by DKA causing arterial occlusion.

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